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The communication of suicidal intentions: a meta-analysis

Published online by Cambridge University Press:  03 June 2016

M. Pompili*
Affiliation:
Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
M. Belvederi Murri
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Italy
S. Patti
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Italy
M. Innamorati
Affiliation:
Department of Human Sciences, European University of Rome, Italy
D. Lester
Affiliation:
Stockton University, New Jersey, USA
P. Girardi
Affiliation:
Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
M. Amore
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Italy
*
*Address for correspondence: M. Pompili, M.D., Ph.D., Department of Neurosciences, Mental Health and Sensory Organs – Suicide Prevention Center, Sant'Andrea Hospital, ‘Sapienza’ University of Rome, 1035-1039, Via di Grottarossa, 00189, Rome, Italy. (Email: maurizio.pompili@uniroma1.it)

Abstract

Background

Among the myths that are often cited about suicide is that ‘people who talk about killing themselves rarely die by suicide’, but the evidence seems to contradict this statement. The aim of this study was to conduct a meta-analysis of studies reporting a prevalence of suicide communication (SC), and to examine the diagnostic accuracy of SC towards suicide in case-control reports.

Method

Eligible studies had to examine data relative to completed suicides and report the prevalence of SC. Data relative to sample characteristics, study definition, modality and recipient of the SC were coded.

Results

We included 36 studies, conducted on a total of 14 601 completed suicides. The overall proportion of SC was 44.5% [95% confidence interval (CI) 35.4–53.8], with large heterogeneity (I2 = 98.8%) and significant publication bias. The prevalence of SC was negatively associated with the detection of verbal communication as the sole means of SC and, positively, with study methodological quality. Based on seven case-control studies, SC was associated with an odds ratio of 4.66 for suicide (95% CI 3.00–7.25) and was characterized by sufficient diagnostic accuracy only if studies on adolescents were removed.

Conclusion

Available data suggest that SC occurs in nearly half of subjects who go on to die by suicide, but this figure is likely to be an underestimate given the operational definitions of SC. At present, SC seems associated with overall insufficient accuracy towards subsequent suicide, although further rigorous studies are warranted to draw definite conclusions on this issue.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2016 

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References

Apter, A, Bleich, A, King, RA, Kron, S, Fluch, A, Kotler, M, Cohen, DJ (1993). Death without warning? A clinical postmortem study of suicide in 43 Israeli adolescent males. Archives of General Psychiatry 50, 138142.CrossRefGoogle Scholar
Barraclough, B, Bunch, J, Nelson, B, Sainsbury, P (1974). A hundred cases of suicide: clinical aspects. British Journal of Psychiatry 125, 355373.Google Scholar
Beck, AT, Lester, D (1976). Components of suicidal intent in completed and attempted suicides. Journal of Psychology 92, 3538.CrossRefGoogle ScholarPubMed
Beck, AT, Weissman, A, Lester, D, Trexler, L (1976). Classification of suicidal behaviors. II. Dimensions of suicidal intent. Archives of General Psychiatry 33, 835837.CrossRefGoogle ScholarPubMed
Beisser, AR, Blanchette, JE (1961). A study of suicides in a mental hospital. Diseases of the Nervous System 22, 365369.Google Scholar
Bernstein, M (1978). The communication of suicidal intent by completed suicides. Omega 9, 19781979.Google Scholar
Breier, A, Astrachan, BM (1984). Characterization of schizophrenic patients who commit suicide. American Journal of Psychiatry 141, 206209.Google Scholar
Brent, DA, Perper, JA, Goldstein, CE, Kolko, DJ, Allan, MJ, Allman, CJ, Zelenak, JP (1988). Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients. Archives of General Psychiatry 45, 581588.CrossRefGoogle ScholarPubMed
Brent, DA, Perper, JA, Moritz, G, Allman, C, Friend, A, Roth, C, Schweers, J, Balach, L, Baugher, M (1993). Psychiatric risk factors for adolescent suicide: a case-control study. Journal of the American Academy of Child and Adolescent Psychiatry 32, 521529.CrossRefGoogle ScholarPubMed
Bulpitt, CJ (1988). Meta-analysis. Lancet 2, 9394.Google Scholar
De Leo, D, Klieve, H (2007). Communication of suicide intent by schizophrenic subjects: data from the Queensland Suicide Register. International Journal of Mental Health Systems 1, 6.CrossRefGoogle ScholarPubMed
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.CrossRefGoogle ScholarPubMed
Dorpat, TL, Ripley, HS (1960). A study of suicide in the Seattle area. Comprehensive Psychiatry 1, 349359.CrossRefGoogle ScholarPubMed
Evidence-Based Medicine Working G (1992). Evidence-based medicine. A new approach to teaching the practice of medicine. Journal of the American Medical Association 268, 24202425.Google Scholar
Farberow, NL, Shneidman, ES, Neuringer, C (1966). Case history and hospitalization factors in suicides of neuropsychiatric hospital patients. Journal of Nervous and Mental Disease 142, 3244.Google Scholar
Foster, T, Gillespie, K, McClelland, R (1997). Mental disorders and suicide in Northern Ireland. British Journal of Psychiatry 170, 447452.CrossRefGoogle ScholarPubMed
Fowler, RC, Rich, CL, Young, D (1986). San Diego Suicide Study. II. Substance abuse in young cases. Archives of General Psychiatry 43, 962965.Google Scholar
Fowler, RC, Tsuang, MT, Kronfol, Z (1979). Communication of suicidal intent and suicide in unipolar depression: a forty year follow-up. Journal of Affective Disorders 1, 219225.CrossRefGoogle Scholar
Giupponi, G, Pycha, R, Innamorati, M, Lamis, DA, Schmidt, E, Conca, A, Kapfhammer, HP, Lester, D, Girardi, P, Pompili, M (2014). The association between suicide and the utilization of mental health services in South Tirol, Italy: a psychological autopsy study. International Journal of Social Psychiatry 60, 3039.CrossRefGoogle ScholarPubMed
Goh, SE, Salmons, PH, Whittington, RM (1989). Hospital suicides: are there preventable factors? Profile of the psychiatric hospital suicide. British Journal of Psychiatry 154, 247249.Google Scholar
Harbord, RM, Whiting, P (2009). METANDI: Stata module to perform meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stata Journal 9, 211229.Google Scholar
Harwood, DM, Hawton, K, Hope, T, Jacoby, R (2000). Suicide in older people: mode of death, demographic factors, and medical contact before death. International Journal of Geriatric Psychiatry 15, 736743.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Hawton, K, Malmberg, A, Simkin, S (2004). Suicide in doctors. A psychological autopsy study. Journal of Psychosomatic Research 57, 14.Google Scholar
Hawton, K, Simkin, S, Gunnell, D, Sutton, L, Bennewith, O, Turnbull, P, Kapur, N (2005). A multicentre study of coproxamol poisoning suicides based on coroners’ records in England. British Journal of Clinical Pharmacology 59, 207212.CrossRefGoogle ScholarPubMed
Heila, H, Isometsa, ET, Henriksson, MM, Heikkinen, ME, Marttunen, MJ, Lonnqvist, JK (1998). Antecedents of suicide in people with schizophrenia. British Journal of Psychiatry 173, 330333.Google Scholar
Isometsa, ET, Heikkinen, ME, Marttunen, MJ, Henriksson, MM, Aro, HM, Lonnqvist, JK (1995). The last appointment before suicide: is suicide intent communicated? American Journal of Psychiatry 152, 919922.Google ScholarPubMed
Isometsa, ET, Henriksson, M, Aro, H, Heikkinen, M, Kuoppasalmi, K, Lonnqvist, J (1994 a). Suicide in psychotic major depression. Journal of Affective Disorders 31, 187191.Google Scholar
Isometsa, ET, Henriksson, MM, Aro, HM, Heikkinen, ME, Kuoppasalmi, KI, Lonnqvist, JK (1994 b). Suicide in major depression. American Journal of Psychiatry 151, 530536.Google Scholar
Isometsa, ET, Henriksson, MM, Aro, HM, Lonnqvist, JK (1994 c). Suicide in bipolar disorder in Finland. American Journal of Psychiatry 151, 10201024.Google Scholar
Isometsa, ET, Henriksson, MM, Heikkinen, ME, Aro, HM, Marttunen, MJ, Kuoppasalmi, KI, Lonnqvist, JK (1996). Suicide among subjects with personality disorders. American Journal of Psychiatry 153, 667673.Google Scholar
Lindqvist, P, Gustafsson, L (2002). Suicide classification – clues and their use. a study of 122 cases of suicide and undetermined manner of death. Forensic Science International 128, 136140.CrossRefGoogle ScholarPubMed
Maltsberger, JT, Buie, DH (1989). Common errors in the management of suicidal patients. In Suicide: Understanding and Responding (ed. Jacobs, D. and Brown, H.N.), pp. 285294. International University Press Inc.: Madison.Google Scholar
Marttunen, MJ, Henriksson, MM, Isometsa, ET, Heikkinen, ME, Aro, HM, Lonnqvist, JK (1998). Completed suicide among adolescents with no diagnosable psychiatric disorder. Adolescence 33, 669681.Google Scholar
McPhedran, S, De Leo, D (2013). Miseries suffered, unvoiced, unknown? Communication of suicidal intent by men in ‘rural’ Queensland, Australia. Suicide and Life-Threatening Behavior 43, 589597.Google Scholar
Nyawira Nyaga, V, Arbyn, M, Aerts, M (2014). Metaprop: a Stata command to perform meta-analysis of binomial data. Archives of Public Health 72, 39.Google Scholar
Orbach, I, Gilboa-Schechtman, E, Ofek, H, Lubin, G, Mark, M, Bodner, E, Cohen, D, King, R (2007). A chronological perspective on suicide–the last days of life. Death Studies 31, 909932.Google Scholar
Owen, G, Belam, J, Lambert, H, Donovan, J, Rapport, F, Owens, C (2012). Suicide communication events: lay interpretation of the communication of suicidal ideation and intent. Social Science and Medicine 75, 419428.Google Scholar
Pirkola, SP, Isometsa, ET, Henriksson, MM, Heikkinen, ME, Marttunen, MJ, Lonnqvist, JK (1999). The treatment received by substance-dependent male and female suicides. Acta Psychiatrica Scandinavica 99, 207213.Google Scholar
Portzky, G, Audenaert, K, van Heeringen, K (2005). Suicide among adolescents. A psychological autopsy study of psychiatric, psychosocial and personality-related risk factors. Social Psychiatry and Psychiatric Epidemiology 40, 922930.Google Scholar
Portzky, G, Audenaert, K, van Heeringen, K (2009). Psychosocial and psychiatric factors associated with adolescent suicide: a case-control psychological autopsy study. Journal of Adolescence 32, 849862.CrossRefGoogle ScholarPubMed
Pouliot, L, De Leo, D (2006). Critical issues in psychological autopsy studies. Suicide and Life-Threatening Behavior 36, 491510.Google Scholar
Rich, CL, Fowler, RC, Fogarty, LA, Young, D (1988). San Diego Suicide Study. III. Relationships between diagnoses and stressors. Archives of General Psychiatry 45, 589592.Google Scholar
Rihmer, Z, Barsi, J, Arato, M, Demeter, E (1990). Suicide in subtypes of primary major depression. Journal of Affective Disorders 18, 221225.Google Scholar
Robins, E, Gassner, S, Kayes, J, Wilkinson, RH Jr., Murphy, GE (1959). The communication of suicidal intent: a study of 134 consecutive cases of successful (completed) suicide. American Journal of Psychiatry 115, 724733.Google Scholar
Rudestam, KE (1971). Stockholm and Los Angeles: a cross-cultural study of the communication of suicidal intent. Journal of Consulting and Clinical Psychology 36, 8290.Google Scholar
Shafii, M, Carrigan, S, Whittinghill, JR, Derrick, A (1985). Psychological autopsy of completed suicide in children and adolescents. American Journal of Psychiatry 142, 10611064.Google Scholar
Shneidman, ES (1996). The Suicidal Mind. Oxford University Press: New York.Google Scholar
Sveticic, J, Milner, A, De Leo, D (2012). Contacts with mental health services before suicide: a comparison of Indigenous with non-Indigenous Australians. General Hospital Psychiatry 34, 185191.Google Scholar
Yessler, PG, Gibbs, JJ, Becker, HA (1960). On the communication of suicidal ideas. I. Some sociological and behavioral considerations. Archives of General Psychiatry 3, 612631.Google Scholar
Yim, PH, Yip, PS, Li, RH, Dunn, EL, Yeung, WS, Miao, YK (2004). Suicide after discharge from psychiatric inpatient care: a case-control study in Hong Kong. Australian and New Zealand Journal of Psychiatry 38, 6572.CrossRefGoogle ScholarPubMed
Zhou, XM, Jia, SH (2012). Suicidal communication signifies suicidal intent in Chinese completed suicides. Social Psychiatry and Psychiatric Epidemiology 47, 18451854.Google Scholar
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